The importance of evidence-based prescriptions
We take an evidence-based approach to medication selection. Our pharmacists and physicians evaluate the clinical value and safety of each drug. To do this, they review evidence from published clinical trials and from our electronic health record system. With this review, we have developed our Medication Formulary (a list of medications we prefer to be covered and used by our members). This process gives our physicians and other prescribers confidence in our formulary.
We also largely restrict visits from pharmaceutical sales representatives who market their products directly to physicians. Instead, our experts provide unbiased, inside information about medications to inform prescribers and our prescribing decisions.
The importance of negotiating prices based on the value of the property
After we have drawn up our list of safe and effective medicines, we buy them directly from the drug manufacturers. We are unique among healthcare organizations because we purchase and distribute prescription medications.
Thanks to our size and ability to effectively use preferred products, we are able to negotiate the lowest possible price. We also buy medicines from a variety of pharmaceutical manufacturers. This helps us secure adequate supplies for our members.
Our approach avoids the complexity and ambiguity often experienced by other health plans that rely on pharmacy benefit managers, known as PBMs, to manage the benefits of their members’ prescription drugs. Our approach to drug procurement is straightforward, without relying heavily on middlemen.
The importance of adopting generic drugs and biosimilars
Because we decide which drugs to cover based on how well they work and how safe they are, we actively encourage the use of generics and biosimilars. We prescribe generics and biosimilars at rates higher than the national average.
Genes are basically identical versions of brand-name drugs. Biosimilars are very similar alternatives to brand name biologics. Both are less expensive and equally effective options. As an added level of safety, Kaiser Permanente also conducts its own testing of select generic drugs to ensure they meet standards for quality and purity.
We saved $200 million by switching to biosimilars for some cancer care. We have also switched most of our members to the latest Humira probiotic alternative. Humira is a prescription injection used to treat rheumatoid arthritis and other conditions. It’s about $7,000 per month. This switch is expected to save Kaiser Permanente nearly $300 million this year alone. These savings translate into lower costs for our members and employer groups.
The importance of tracking safety and results
Our electronic health record system allows us to monitor the safety and effectiveness of the medicines we prescribe. This data protects not only our members but everyone. For example, our data reported early concerns about the safety of the arthritis drug Vioxx, which was subsequently withdrawn from the market.
Pharmacists have access to a patient’s and provider’s member’s complete electronic health record if questions or concerns arise, improving the safety of our drug use processes. Our pharmacists actively track medication adherence to patients with chronic diseases and communicate with them regularly about how to take their medications more effectively.
Every patient deserves access to high-quality, affordable medicines when needed. Learn more about the prescription drug policies we support.